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Mid Staffs A&E nurses were 'punished over targets'

6 March, 2013 | By The Press Association

Accident and emergency nurses in the hospital at the centre of the Stafford care scandal were “punished” if they spent too much time caring for patients because of the “draconian” management’s demand to meet waiting time targets, a tribunal heard.

Nurses were often marched up to account for themselves to executives at Stafford General Hospital if they breached the four-hour limit for treating patients and “made a spectacle of”, it was claimed.

The allegations came at a Nursing and Midwifery Council misconduct hearing into the standard of care provided by two nursing sisters at the hospital at the centre of the Francis Report into care at the Mid Staffordshire Foundation NHS Trust, where hundreds of patients are said to have died unnecessarily.

Tracy White faces five charges of misconduct relating to patient care and falsifying waiting times, and Sharon Turner faces six, including falsifying waiting times, patient care and racist conduct, relating to their time in charge of the A&E department in 2007.

Katherine Kelly, a former sister there, said there was a “culture of bullying” among senior management who shouted at nurses who breached waiting limits.

She added: “The management at the time was draconian and nurses were often marched up to the executive office in relation to breach times in the A&E department.

“The A&E sisters would also frequently be in trouble for allowing breaches of the four-hour target.”

She added: “Nurses were punished by the trust if they spent more time with the patients, if this resulted in them breaching the four-hour target.

“Nurses who had fewer or no breaches received high praise from management. Nurses who had breaches were made a spectacle of and made to feel they were no good at their job.”

The punishment was normally unofficial, she said, including one sister who was “undermined in her role” by having junior nurses do her job instead of her.

Ms Kelly told the tribunal that in October 2007 Turner told a nurse, Helene Donnelly, “my advice is to lie about the breach time”, when she rang through from the minor injuries section saying they had patients who were about to clock up four hours in A&E.

Ms Kelly told the hearing that although at the time she assumed it was said seriously, when she made a statement last year she thought it was “off the cuff”, and now did not know either way.

Ms Donnelly, who gave evidence to the Francis Inquiry, told the hearing that patient records were “routinely” doctored in the “chaotic” department, which lacked a permanent manager at the time, to hide breaches in waiting time limits.

A white board carrying patient details often had admission times rubbed out, something which would have been seen by management, she claimed.

White is alleged to have told a seriously ill elderly patient who later died that she was a “naughty little monkey” who was just constipated and had not taken her laxative.

She allegedly refused to help lift the woman from a wheelchair on to a bed, saying: “I’m not doing this. I’m not hurting my back. We don’t need to get her on a trolley anyway, she is going to breach (waiting time target) in a minute,” and telling the junior doctor examining her to help with another patient.

The woman, known as Patient B, was discharged but died the following day from a pulmonary oedema.

White is also accused of saying “she can wait if you can do that to your baby” when a woman came into A&E suffering from bleeding after having an abortion.

Turner is accused of making racist comments, including likening an Asian junior doctor to a suicide bomber and describing another as “Osama’s mate”.

A third was frequently derogatorily referred to as “him in the turban”, and a female gynaecologist pointed out as “her in the yashmak”, Ms Donnelly claimed.

Turner, who was described as “foul-mouthed”, is also accused of swearing about patients where they could hear her, saying they “can f****** wait”, “they want to get f****** real” and “I don’t give a flying f***”.

James Townsend, representing both women, said they did not say the things they are accused of.

He questioned Ms Donnelly’s memory of events six or seven years ago and accused her of targeting the nurses because of “bad feeling” toward them over remarks made about her mother-in-law - a nurse at the hospital - and a complaint made about her own conduct. She denied this.

Ms Kelly said Turner’s dry sense of humour could be “not politically correct” but with no intended malice.

“Sharon would get very frustrated about a group of Asian junior doctors who would only speak to each other in their own language, which was not English,” she said.

“I recall that Sharon would make tongue-in-cheek remarks highlighting that the junior doctors were being rude.”

White and Turner contest the charges. The hearing continues.

Readers' comments
(19)

Anonymous | 6-Mar-2013 12:30 pm

omg im horrified at the treatment to staff and the treatment to patients

The problem is that its hard to pin down exactly how you are being punished for not meeting targets but remarks such as 'you need to work smarter' or 'you will be performance managed on this' all hint that you are not up to the job if you don't comply with the form filling tick box tasks that in reality take time away from patient care - that culture speaks volumes about the priority given to hands on care and therefore to patients. At the end of the day if staff are treated badly the risk of patients being treated badly is greatly increased. I don't know the details of this case and am not condoning bad care but if moving a patient from a wheelchair brings the need for risk assessments or an incident form if anyone gets hurt, the need to justify why waiting times were not within target and all the paper work involved in an admission it means that speedy discharge ticks more boxes than helping the patient and this is a recipe for disaster. No one wants to find that they have been pushed so far that the patient is seen as a commodity to be managed but it is increasingly hard to keep some perspective.

I recently found myself surveying a palliative patient and wondering how on earth I was going to justify it if they developed a pressure sore as moving and handling [at home] was fraught with difficulty when I realised that I needed to be thinking how can I make sure they are comfortable and be able to be confident if I ensured care was given to the best of our abilities that we could not be criticized. That patient has now died - comfortable, peaceful and without a hint of pressure damage. Lesson learnt - in part due to the Frances report helping me to see the pitfalls of targets.

This is amazing. Sorry for being a manager and posting here, but our equivalent of the NT is running a huge story about David Nicholson being taken to court for corporate manslaughter by a member of the public. Papers have just been filed by his lawyers today.

Someone needs to get their facts right.The Mother-in-law did not work at the hospital she worked in the community. However she has had experience of these 2 Sister and the poor care and bullying they are accused off.

Dorrell has not yet replied to my suggestions about a 'mechanism' for 'culture change' - but I got a letter from my MP today, re the 38 degrees north petition I did much more recently (which sent an e-mail to him). My MP doesn't like the commissioning regulations - so, he is 'on the same side as me'.

There is a letter, I think it was in The Times today, about this recent 're-wording' of the rules for CCG/Bs re 'purchasing services'. I think it was from a senior medic, who acerbically wrote something like (my phrasing, here):

'Even the few clinicians who supported the Bill, have now come to realise that such a revision to the rules is impossible, because to do what was promised in The Lords conflicts with the rest of the Act'.

As with everything else, I want to see the revised wording, then I'll comment on if I like them or not !

I think (re the letter) that an e-mail to me might have been more enviromentally friendly - perhaps my MP only got my address, not my e-mail address ?